PREGNANCY AND ORAL HEALTH CARE

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1 Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending THIS WEBCAST IS FOR CONTINUING EDUCATION CERTIFICATION ONLY. THE PRESENTERS CONTRACTUALLY CONFIRM THAT THEIR PARTICIPATION DOES NOT PRESENT ANY CONFLICTS OF INTEREST. PREGNANCY AND ORAL HEALTH CARE Nate Mandelman, MD Ron Salyk, DDS Morris Heights Health Center Bronx, NY

2 OVERVIEW OF PREGNANT PATIENT Pregnant patient has special dental needs Pregnant condition makes many dental providers nervous The major tendency of dentists is to undertreat An agreed upon body of knowledge can guide the dentist

3 OVERVIEW OF THIS PRESENTATION Medical/physiological changes in pregnant patient Special oral health needs of pregnant patient Pregnancy and common medications used in dentistry (Antibiotics, Anesthetics, Analgesics) X-RAYS AND PREGNANCY Suggested protocol for treatment, by trimester Consults Questions????????????????????

4 RECENT REFERENCE Good recent overview of all these topics: NEW YORK STATE DENTAL JOURNAL JANUARY 2004

5 MEDICAL/PHYSIOLOGICAL Hormonal changes CHANGES Changes in immune response Increased gingivitis/bleeding Increased susceptibility to infection Gestational diabetes Pregnancy tumors

6 MEDICAL/PHYSIOLOGICAL CHANGES Increased caries susceptibility? (diet changes-increased sugar?) (poor hygiene-pain/bleeding?) (a tooth lost for each pregnancy?) Relationship between periodontal disease and low birth weight?????????????

7 SPECIAL ORAL HEALTH NEEDS Tooth loss and gum disease is not normal Hygiene instruction for home care Prophy/scaling for all Chlorhexidine/H202 OK for pregnant

8 SPECIAL ORAL HEALTH NEEDS Educational opportunity- mother and baby Baby-diet, gauze wipe, fluoride (water) Mom-original S. mutans comes from mom Her hygiene protects her child

9 MEDICATIONS-ANTIBIOTICS ANTIBIOTICS General Rule-Minimize medications (extreme examples-thalidomide, DES) Despite this rule, treat pain and infection Pregnancy should not mean that infection is not treated, pain is not relieved or obvious dental need is not taken care of What specific antibiotic recommendations/contraindications exist?

10 MEDICATIONS-ANTIBIOTICS ANTIBIOTICS AVOID: TETRACYCLINE FAMILY AVOID: ERYTHROMYCIN ESTOLATE AVOID: METRONIDAZOLE (DENTAL USE) MOST COMMON DENTAL ANTIBIOTICS ARE SAFE

11 MEDICATIONS-ANTIBIOTICS ANTIBIOTICS PEN V, AMOXICILLIN, AMPICILLIN, CLINDAMYCIN, CEPHALOSPORINS ERYTHROMYCIN (EXCEPT ESTOLATE)=CATEGORY B CLARITHROMYCIN= CATEGORY C YOU CAN PREMEDICATE AND TREAT INFECTIONS SAFELY

12 MEDICATIONS-ANALGESICS ANALGESICS ASPIRIN / ASA- AVOID, ESP. 3 RD TRIM (C/D) IBUPROFEN / MOTRIN- AVOID, ESP. 3 RD TRIMESTER (B/D) NAPROXEN / NAPROSYN- AVOID, ESP. 3 RD TRIMESTER (B/D) DIFLUNISAL / DOLOBID- AVOID, ESP. 3 RD TRIMESTER (C/D) WHAT S LEFT????????????

13 MEDICATIONS-ANALGESICS ANALGESICS TYLENOL / ACETAMINOPHEN-BEST FOR MILD TO MODERATE PAIN STRONGER? TYLENOL 3 (wt. CODEINE) VICODIN (TYLENOL WITH HYDROCODONE) DEMEROL / MEPERIDINE

14 MEDICATIONS-ANESTHETICS ANESTHETICS THORNY AREA WITH SOME DISAGREEMENT NO DEFINITIVE STANDARD MAIN ISSUE-MEPIVICAINE (CARBO) 3% WITHOUT VASOCONSTRICTOR VS. LIDOCAINE 2% WITH EPI. 1:100,000 DOES EPI STIMULATE UTERINE MUSCLE? CONCENTRATION? IN BLOODSTREAM?

15 Lidocaine vs. mepivicaine Category B 2% Epi will keep it local Less likely to re-inject Less drug of better category Uterine muscle effect? Category C 3% (50% MORE DRUG) Leaves tissue more readily More likely to reinject More drug of a worse category No muscle effect

16 MEDICATIONS-ANESTHETICS ANESTHETICS MORE EXPERTS ARE LEANING TOWARDS LIDO WT EPI 1:100,000 SEE NYSDJ JANUARY 2004 NOTE: ARTICAINE 4% CATEGORY C MARCAINE: CATEGORY C

17 PREGNANCY AND X-RAYSX MOST FEARED/MISUNDERSTOOD ASPECT GENERAL RULE-MINIMIZE X=RADIATION GENERAL RULE-YOU CAN T TREAT MUCH WITHOUT X-RAYS! CAN YOU EXTRACT? DEEP EXCAVATION? ENDO?

18 PREGNANCY AND X-RAYSX SENSIBLE PLAN: TAKE NEEDED X-RAYS POSTPONE FULL MOUTH SERIES POSTPONE ROUTINE RECALL BW S (SOME DISAGREEMENT ON THIS) NOTE IN CHART: PREGNANT PATIENT X-RAYS TO BE TAKEN AFTER BIRTH- INFORM PATIENT

19 PREGNANCY AND X-RAYSX WORST TRIMESTER= FIRST SINGLE DENTAL FILM, COLLIMATED TUBE, AIMED AT HEAD, LEAD APRON RADIATION EXPOSURE IS ALMOST UNDETECTABLE! BALANCE X-RAY RISK VS. RISK OF NOT TREATING INFECTION AND PAIN OR BAD DIAGNOSIS WITHOUT FILM

20 PREGNANCY AND X-RAYSX YOU MAY BE X-RAYING PREGNANT PATIENTS ALREADY HAS PATIENT MISSED A PERIOD? ASK, POST NOTES AND SIGNS, MEDICAL HISTORY URINE PREGNANCY TEST ON SITE?

21 GENERAL RECOMMENDATIONS CONSENSUS????????? PRE-PREGNANCY AND EARLY PREGNANCY COUNSELLING-INCLUDE A DENTAL COMPONENT PROPHY/HYGIENE IN ALL TRIMESTERS PAIN/INFECTION TREAT IN ALL TIMESTERS TREAT DEEP CARIES LIKELY TO BECOME PROBLEMATIC

22 GENERAL RECOMMENDATIONS CONSENSUS????????? SECOND TRIMESTER-BEST FOR GENERAL RESTORATIVE FIRST TRIMESTER-WORST FOR CHEMICALS AND RADIATION THIRD TRIMESTER-KEEP APPTS. SHORT,CHAIR POSITION MAY BE PROBLEMATIC BETTER LEANING ON LEFT SIDE

23 GENERAL RECOMMENDATIONS CONSENSUS????????? NO CONTRAINDICATIONS FOR DENTAL RESTORATIVE MATERIALS, INCLUDING AMALGAM RECOMMEND POSTPONING TRULY ELECTIVE AND INVASIVE PROCEDURES- 3 RD MOLAR EXTRACTIONS, CROWN AND BRIDGE, PERIO SURGERY.

24 CONSULTS NOT GENERALLY NECESSARY FOR HEALTHY PREGNANT PATIENTS IF NEEDED, BE SPECIFIC ON PROCEDURE PLANNED, MEDICATIONS PLANNED, ETC. OTHER REASONS FOR CONSULT?

25 QUESTIONS??? I THINK WE VE STIRRED UP ENOUGH ISSUES..

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